Provider Demographics
NPI:1083782965
Name:WATSON, HILARY STEPHEN II (MD)
Entity type:Individual
Prefix:DR
First Name:HILARY
Middle Name:STEPHEN
Last Name:WATSON
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2932
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70404-2932
Mailing Address - Country:US
Mailing Address - Phone:985-345-5500
Mailing Address - Fax:985-345-5555
Practice Address - Street 1:1665 DOVE PARK RD
Practice Address - Street 2:SUITE 700
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70471-1919
Practice Address - Country:US
Practice Address - Phone:985-345-5500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA10774R174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1991601Medicaid
LA1991601Medicaid
LAF83653Medicare UPIN